Development of Online Clinical Microbiology Laboratory Unknowns: Active Learning for Online, Hybrid, and In-Person Courses

ABSTRACT

Microbiology laboratory classes allow students to make connections between theoretical concepts and clinical practice through experiential learning. In the past, most laboratory sessions were taught in-person, on-site. However, advances in multimedia and the ability of learning management systems to provide online course delivery allow laboratory assignments to be taught through online simulations. An online unknown identification activity promotes active learning while allowing instructors to assess student knowledge. This article describes the creation of online clinical microbiology unknown assignments which are suitable for complementing a variety of microbiology courses in an online, hybrid, or in-person format.

INTRODUCTION

Pedagogical research has emphasized the benefits of incorporating active learning strategies into classes to create interest and help students make connections between textbook learning and the real world (1–3). Laboratory classes provide an opportunity for active learning through experiential learning (4, 5). Most laboratory sessions have been taught in-person, on-site. However, advances in multimedia and learning management systems (LMSs), the ubiquity of learning devices among students for online instruction, and better internet connectivity now allow laboratory assignments to be taught through online simulations.

Most literature regarding online microbiology instruction is focused on a specific assignment (e.g., midterm or final exam) or temporary replacement of in-person lab sessions during the COVID-19 pandemic (6–8). This article describes the creation of online unknown identification activities (referenced in this article as “unknowns”) suitable for complementing a variety of microbiology courses. They can be used as (i) a preassignment to prepare students for in-person laboratory sessions, (ii) supplemental online assignments in hybrid courses, and (iii) laboratory simulations for an online, asynchronous course. The information in this article is applicable to bioscience and microbiology disciplines and can stimulate ideas of how to create online activities for other courses.

PROCEDURE

The objective of the online laboratory unknowns was to design guided assignments that integrate the application of clinical microbiology concepts through interpretation of videos and pictures of simulated patient cultures for microorganism identification. Each course module contains two to seven unknowns that correspond to the theoretical objective concepts the student is learning.

The online laboratory simulations provide real-world experiences of patient cultures and infectious disease correlation, each comprised of five segments: (i) colony morphology interpretation, (ii) Gram stain interpretation, (iii) selection of identification testing, (iv) interpretation of testing, and (v) final identification of an organism(s) in culture. Case studies also include (vi) patient case analysis and infectious disease correlation, (vii) antimicrobial susceptibility testing interpretation, and (viii) final culture report to the physician. An example is provided in Appendix S1 in the supplemental material.

Student learning objectives

The student learning objectives (SLOs) for the online unknowns were designed to develop the students’ skills in the clinical microbiology laboratory. The online laboratory sessions assess four SLOs. After completion of the online unknowns, the student should be able to (i) demonstrate (or apply) a basic (or working) knowledge of the theory and techniques used in standard laboratory procedures performed in clinical microbiology laboratories (the words in parentheses here indicate a more advanced level of action in the SLO for a higher-level course); (ii) evaluate standard laboratory protocols and algorithms used in the diagnosis and treatment of infectious disease; (iii) accurately interpret clinical laboratory tests to identify microorganisms in infectious disease; and (iv) evaluate how microbiology laboratory results contribute to the diagnosis and treatment of infectious disease states.

Therefore, the laboratory unknowns are the fundamental assessment of the student’s skills acquired throughout the course, including the ability to interpret and evaluate the laboratory tests, communicate these results accurately, and correlate the results with the diagnosis and treatment of infectious diseases. The SLOs can be adjusted based upon the course level and should be provided to the students in the course syllabus.

Organization

The unknowns simulate the culture interpretation process for patient cultures and testing in the clinical microbiology laboratory. The assignment questions are designed to guide the student through the thought process and replicate real-life culture manipulation. Each step within the process is developed into a question that makes the student stop and reflect on what should be done at that point and what the next step would be.

The unknown labs in the first half of the semester consist of single-organism identification cultures which directly guide the student through the process. The second half focuses on case studies and mixed cultures based on body sites of infection (e.g., respiratory, wound, urine, and blood samples). This allows the student to correlate whether the isolated microorganisms are normal flora, contaminants, or pathogens. Appendix S2 provides an example of the theoretical concepts, online demonstration videos, and written procedures presented within the same learning unit as the assigned online laboratory unknowns.

Creation

Microbiology culture and identification test unknown silent videos were recorded to embed in the online laboratory simulations. The videos allowed students an unobstructed close-up view with a real-life perspective. Pictures were taken of the different agar media, colony growth, identification tests, and specimens to use in conjunction with the videos.

The LMS (see Appendix S3) was chosen to create the online unknowns, because it allowed for seamless integration of online learning materials, including creating the unknowns as a graded quiz assignment within a specific learning unit. The quiz feature allowed the videos and pictures to be embedded within the questions, providing a real-life simulation of the culture process. The students could pause and rewatch the content as many times as needed. In addition, the LMS gave students the opportunity to engage within the online course and receive feedback from faculty about skill development and learning achievement.

The assignment included a combination of short answer and multiple choice questions. However, all questions could be multiple choice to make grading easier for large class sizes. The manually graded short answer questions were used for colony morphology interpretation, final culture reporting, and correlation questions. The multiple choice questions were reserved for test interpretation and organism identification, which the LMS automatically graded.

Students were instructed to document their results throughout the unknown assignment, simulating the culture interpretation process in the laboratory. Backtracking to previous questions was prohibited within the quiz, and this was clearly communicated to the students within every unknown, course instructions, and syllabus. The answer to the previous question was given to the student at the beginning of the next question. With this format, the student was not penalized if they got off track. Upon submission of the assignment, feedback was provided, including the student’s answer selection, correct answer, and additional explanations embedded into the questions. Immediate feedback allowed the student to evaluate their progress in real time and review concepts corresponding to missed questions.

Safeguards to increase academic integrity include adding specific dates of availability, time limits for completion, randomizing answers, assigning different unknowns to each student, or rotating unknowns between semesters.

Student feedback

Students filled out a survey regarding the course learning activities. Most comments (see Appendix S4) regarding the unknowns were positive, often indicating that the online unknowns were the most beneficial learning activity in the course. Based on student feedback, the online unknowns allowed students to apply the information, stay engaged with the material, and feel a connection with the clinical microbiology laboratory.

CONCLUSION

Modifications to microbiology curricula can be necessary to address changes in technology, pedagogy, and societal demands. Online laboratory unknowns provide active learning opportunities in online, in-person, and hybrid courses. They can be used as a supplement for courses with in-person laboratory sessions or as a component in online courses. Using an LMS creates an assignment that is standardized and available to all students. Online unknowns improve student learning by providing the opportunity to interpret microbiology laboratory test results and correlate the results to infectious disease.